Case Report

Signalment: Charlie, 13 y/o castrated male, Border Collie mix, weighing 23.4kgs
Clinical History: Charlie presented to his primary care veterinarian on August 5, 2014, ADR
with anorexia and lethargy. Blood work performed on 8/5/14 showed a packed cell volume of
30%, total solids of 5.0 g/dL and clear serum. An in-house fecal flotation was performed to rule
out intestinal parasites; an Idexx 4Dx SNAP test was performed to rule out tick-borne disease; no
oocysts were seen on the fecal examination, and the SNAP test was negative for E.
Canis/E.Ewingii, Anaplasmosis, D. Immitis, and B. Burgdorferi. Charlie was started on
Minocycline 100mg, 2 capsules PO BID for 10 days in case of falsely negative results.
On 8/7/14, Charlie presented to the ICU for lethargy and anorexia. Upon initial examination, he
was found to be febrile, with a temperature of 103.5 F. Initial blood work revealed pancytopenia
and light straw-colored serum; PCV/TS = 28%/4.7g/dL; WBC = 3400 u/l; and 3-5 platelets/HPF.
Antech PCR tick disease and lyme serology were performed and returned negative for tick-borne
diseases. An abdominal ultrasound was performed and revealed splenomegaly. Aspirates of the
spleen were taken and analyzed. Lymphoid hyperplasia, extramedullary histiocytes,
hematopoiesis differentiation and erythrophagocytosis without cancerous indications was
observed.
On 8/9/14 a bone marrow aspirate was performed on each humerus. Aspirates revealed primarily
blood. In-house diagnostics revealed excessive fat (indicative of decreased marrow activity) and
a decrease the number of cells, with few precursor cells. No cancerous cells were noted. Antech
diagnostics of the aspirates revealed polychromatophilic red blood cells, marrow and stromal
cells devoid of hematopoietic precursors, few plasma cells, small marrow spicules,
megakaryocytes, marked myeloid hypoplasia, and possible myelofibrosis.
Doxycycline 100mg BID for the treatment of ehrlichiosis was prescribed, as the minocycline had
been causing Charlie to vomit. Owner was advised to continue Vitamin B12 treatment and was
also given Cerenia 60mg PO SID x 4d and Tramadol 50mg PO up to TID PRN.
On 8/20/14, Prednisone 20mg PO SID was prescribed.
Presenting Signs: Charlie presented to the ICU on August 27, 2014 at 7:26 AM. At 2:30 AM
the same day, the owner notice that Charlie was unable to stand; he was carried in to the hospital
by the owner at the time of presentation. The owner stated that his appetite and water intake have
been normal and no episodes of vomiting or diarrhea had occurred.
Physical Examination: T: 105.4 F. P: 130bpm, femoral pulses strong and synchronous, mild
tachycardia. R: Panting, mildly elevated respiratory effort. MM/CRT: pink, 1 second, normal
hydration, slightly increased salivation. LOC: Quiet, depressed, responsive. Patient weak and
ataxic, requiring support to stand and walk. Mild epistaxis and petechiation observed.
Laboratory Tests: CBC performed, revealing 0-3 platelets/HPF and continued pancytopenia.
Diagnosis: Pancytopenia, splenomegaly, anemia
Treatment: Patient was immediately started on LRS 1x maintenance, at 63 mL/hr. His vital
signs were monitored q1h for the first 4h, then q4h. 2 tbsp of Royal Canin GI Low Fat Diet
offered q4h and appetite monitored. Walks q4h. Unasyn 515mg administered IV q8h.
Prognosis: Guarded to poor with appropriate course of treatment. Recommend PRBC
transfusion and plasma transfusion. Patient continues to experience a high fever despite course of
broad-spectrum antibiotics. His appetite has been good and he has eliminated well when walked
outside, however he has remained weak and depressed.
Outcome: Charlie was humanely euthanized on 8/29 due to a combination of his guarded
prognosis and owner financial constraints.